Matthew Cooperberg, MD, on racial disparities in prostate, bladder cancer outcomes

In this video, Matthew R. Cooperberg, MD, MPH, comments on disparities data highlighted in the recent Cancer Statistics, 2025 report from the American Cancer Society. Cooperberg is a professor of urology and epidemiology & biostatistics at the University of California, San Francisco Helen Diller Family Comprehensive Cancer Center as well as the chief of urology at the San Francisco VA medical center.

Video Transcript:

Prostate cancer has the greatest racial disparity in terms of excess mortality for Black compared to White patients of all the major human cancers. This has been observed and validated year after year, going back 25, 30 years. Black patients have over 2-fold excess mortality compared to White men, and that has been fairly consistent; the actual rate ratio has hovered between 2 and 2.5 for many years. It does seem to be potentially on a downtrend in the last couple years. This is partly because, at least in some contexts, we've been screening younger Black men a little bit more intensively, which is exactly the right thing to do if we want to address the mortality disparity. There's also been a lot of focus on this disparity for a lot of years in terms of research and trying to understand what drives it. The answer to that question, by the way, is it's complicated and it's multifactorial. There is clearly a genetic component, and we see this with global epidemiologic data. The highest rates of prostate cancer mortality in the world are seen in West and Southern Africa and in the Caribbean, specifically. So, this is not simply a reflection of social demographics or of human development index in the global epi data, but then you layer on to that all the social and structural determinants of health and structural inequalities that have persisted for decades, that exacerbate whatever genetic substrate we're dealing with.

It does not seem to be so much an access to care issue. When you look at screening rates, they actually have been comparable over many years. We don't really see treatment disparities in terms of getting access to surgery and radiation. From the point of diagnosis forward, outcomes really appear to be pretty much the same for Black and White men once you adjust for risk factors at the time of diagnosis. The story really appears to be upstream of diagnosis. There have been some nice modeling studies, again, from the CISNET group, who looked at the mortality downtrend and trying to understand the impact of screening. It's the same statisticians at Fred Hutch and Michigan and Erasmus, who concluded that the trajectory for prostate cancer is very similar in Black and White men, but the whole thing starts about 5 years earlier for Black men. This is the basis of the rationale for earlier screening for Black men, which is now formalized in the AUA screening guidelines [and] in the American Cancer Society [guidelines]. Pretty much all of them at this point, except for the US Preventive Services Task Force, recommend a 5 year earlier start for patients with risk factors; Black race, family history, any known genetic predisposition like BRCA, [all] would indicate starting earlier, maybe as early as 40.

When you look at some of the other cancers, you see other stories. [If] you look at bladder cancer, in this update here, it's a very different story. In bladder cancer, for reasons that are not particularly clear, in terms of the population mortality rate, it's actually a little bit lower for Black compared to White patients, but the outcomes after diagnosis are substantially worse. It's almost the opposite situation as in prostate cancer. In prostate, Black men are getting more and worse prostate cancer, but outcomes are similar once you've got the diagnosis; bladder cancer, it's the opposite. Again, for reasons that are not clear, there seems to be less lethal disease at the population level, but outcomes are substantially worse from diagnosis forward, which tells us there we really do have an access to care and quality of care challenge to take on.

This transcript was AI generated and edited by human editors for clarity.